The American Way of Birth

The New York Timesrecently published a major article by Elisabeth Rosenthal on “The American Way of Birth, Costliest in the World.”

The New York Timesrecently published a major article by Elisabeth Rosenthal on “The American Way of Birth, Costliest in the World.”

The article is full of the usual “The U.S. can’t do anything right: every European country is better than we are,” whining (it’s curious that the Left doesn’t apply the same thinking to abortion policy), but once you get beyond all that, there is plenty of food for thought here.

For one thing, we’ve been told for decades that American patients aren’t very well informed or assertive, so we need sharp-penciled experts to manage our health care for us. The experts will get us the best deal, and we don’t have to worry our pretty little heads about it.

Well, maybe not. The article says –

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups.

Could the average consumer do any worse?

The article looks at the struggles of a couple of such consumers, people who do not have maternity coverage. One is Renee Martin –

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Another such couple was the Sullivans. They bought a $4,000 “pregnancy package” from the local hospital, but it “did not cover extras like amniocentesis,” –

So when the obstetrician suggested an additional fetal heart scan to check for abnormalities, they were careful to ask about price and got an estimate of $265. Performed by a specialist from the Children’s Hospital of Philadelphia, it took 30 minutes and showed no problems — but generated a bill of $2,775.

The bill was ten times the estimate. It took them months of arguing but the hospital finally “honored the estimate.”

And that is what our system needs. Not third-party payers who know they can always raise premiums to cover these ridiculous costs so never bother to argue, but engaged (and sometimes enraged) consumers who refuse to be treated like patsies. Inject millions of such consumers into our system and we will soon see hospitals find a way to price services fairly.

Another such couple was Dr. Marguerite Dane and her physician husband, “both associate professors of family medicine and Georgetown Medical School.”

After her daughter was born five years ago, Dr. Dane was flabbergasted by the line items on the bills, many for blood tests she said were unnecessary and medicines she never received.

So when she became pregnant again in 2011, she decided to be more assertive about holding down costs. After a routine ultrasound scan at 20 weeks showed a healthy baby, she refused to go back for weekly follow-up scans that the radiologist suggested during the last months of her pregnancy even though medical guidelines do not recommend them. When in the hospital for the delivery of her son Ellis in February, she kept a list of every medicine and every item she received.

You can bet there isn’t an insurance company in America that would be so vigilant. When I was working at Blue Cross Blue Shield of Maine in the 1980s, we never bothered even looking at a bill under $5,000. It simply wasn’t worth the expense of paying professional staff review these items. Consumers are more than willing to keep track of all this — when it is THEIR money at stake.

But, of course, that is not how The New York Times sees it. No, they think it is a horrible thing that anyone should be burdened with such a responsibility. It is far better, in their view, to double down on using remote experts to define what care is delivered at what cost, even as they acknowledge that –

To control costs in the United States, patients may also have to alter their expectations, including the presence of an obstetrician at every prenatal visit and delivery.

But salvation is close at hand –

Starting next year, insurance policies will be required under the Affordable Care Act to include maternity coverage, so no woman should be left paying entirely on her own, like Ms. Martin. But the law is not explicit about what services must be included in that coverage.

So, you may not know what services you will get, or whether they are the services you would like to have, or whether your insurance company will be any more vigilant than they were in the past, but at least you won’t “be left paying entirely on (your) own.” And isn’t that the most important thing?